Healthcare Provider Details

I. General information

NPI: 1669173829
Provider Name (Legal Business Name): SHAAN SEHGAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S DALE MABRY HWY STE 101A
TAMPA FL
33629-5837
US

IV. Provider business mailing address

14722 HERONGLEN DR
LITHIA FL
33547-3867
US

V. Phone/Fax

Practice location:
  • Phone: 813-957-4689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN26894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: